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NPI Code Detail

MEDICARE: DEEATRA SEABORN CRADDOCK PHARMD

MEDICARE: DEEATRA SEABORN CRADDOCK PHARMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist40081TX

General Provider Information

NPI Number : 1629121397
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEEATRA SEABORN CRADDOCK PHARMD
Provider Business Mailing Address
First Line : 3869 HARRISON DR
Second Line :
City : CARROLLTON
State : TX
Zip : 75010-6328
Country : US
Telephone Number : 214-731-0777
Fax Number :
Provider Business Practice Location Address
First Line : 2500 LILLIAN MILLER PKWY
Second Line :
City : DENTON
State : TX
Zip : 76210-2902
Country : US
Telephone Number : 940-382-1618
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/18/2007
Last Update Date : 07/08/2007

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